Age-specific prognostic value of 1-year changes in cardio-ankle vascular index

The prognostic significance of longitudinal changes in the cardio-ankle vascular index (CAVI) remains unclear. We investigated the association between 1-year changes in CAVI and subsequent cardiovascular events according to age. A total of 4032 participants with cardiovascular risk factors who were enrolled in the prospective multicenter Coupling Registry and had undergone CAVI measurements at baseline and 1 year were classified into four groups using a CAVI cutoff of 9: good ( < 9 at both time points, n = 1841), improved ( ≥ 9 to <9, n = 268), worsened ( < 9 to ≥9, n = 408), and persistently high ( ≥ 9 at both time points, n = 1515). The primary outcome was a composite of stroke, coronary artery disease, sudden cardiac death, heart failure, and aortic dissection. Multivariable Cox proportional hazards models assessed associations between CAVI changes and outcomes. CAVI increased from 8.80 ± 1.34 at baseline to 8.88 ± 1.35 at 1 year ( P < 0.001). During a median 60-month follow-up (49–63 months), 155 cardiovascular events occurred. In the overall cohort, neither the worsened group (HR, 1.56; 95% CI, 0.93–2.62) nor the persistently high group (HR, 1.10; 95% CI, 0.72–1.68) was significantly associated with cardiovascular events compared with the good group. Among participants aged <65 years, the worsened group (HR, 3.36; 95% CI, 1.18–9.58) and persistently high group (HR, 2.68; 95% CI, 1.11–6.50) had higher cardiovascular risk. No significant associations were observed among participants aged ≥65 years. In conclusion, among patients aged <65 years with cardiovascular risk factors, both worsening and persistently elevated CAVI were independently associated with increased cardiovascular risk.